Provider Demographics
NPI:1942587720
Name:SERENITY HOME CARE, LLC
Entity Type:Organization
Organization Name:SERENITY HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CELESTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANIEKWE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:678-768-5696
Mailing Address - Street 1:2730 N BERKELEY LAKE RD NW
Mailing Address - Street 2:BUILDING 1200, SUITE105
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-1748
Mailing Address - Country:US
Mailing Address - Phone:678-768-5696
Mailing Address - Fax:
Practice Address - Street 1:2730 N BERKELEY LAKE RD NW
Practice Address - Street 2:1200-(105)
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-1748
Practice Address - Country:US
Practice Address - Phone:678-768-5696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-08
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA067-R-0948251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health